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Posterior-based Osteotomies for Deformity Correction.

Evan F Joiner1, Praveen V Mummaneni2, Christopher I Shaffrey3

  • 1Department of Neurological Surgery, Columbia University-NewYork Presbyterian Hospital, 710 West 168th Street, 4th Floor, New York, NY 10032, USA. Electronic address: https://twitter.com/efjoiner.

Neurosurgery Clinics of North America
|September 17, 2023
PubMed
Summary
This summary is machine-generated.

Posterior osteotomies correct adult spinal deformity by restoring lordosis. Different posterior osteotomy types suit varying patient needs, from modest to extensive correction, with trade-offs in complexity and complication risk.

Keywords:
Adult spinal deformityLumbar lordosisPedicle subtraction osteotomyPosterior column osteotomyVertebral column resection

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Area of Science:

  • Orthopedic Surgery
  • Spinal Deformity Correction
  • Surgical Techniques

Background:

  • Adult spinal deformity (ASD) often requires surgical correction to restore spinal alignment and lordosis.
  • Posterior-based osteotomies are key surgical techniques for addressing ASD.
  • The choice of osteotomy depends on the anterior column's fusion status and deformity characteristics.

Purpose of the Study:

  • To delineate the indications and comparative effectiveness of different posterior-based osteotomies for adult spinal deformity.
  • To guide surgical decision-making based on patient-specific factors and deformity severity.

Main Methods:

  • Review and comparison of posterior-column osteotomy, pedicle subtraction osteotomy, and vertebral column resection.
  • Analysis of suitability based on anterior column fusion status and deformity type (sagittal, multiplanar, focal).

Main Results:

  • Posterior-column osteotomies are suitable for unfused anterior columns and non-focal sagittal deformities needing modest correction.
  • Multi-level posterior-column osteotomies can achieve significant correction for more extensive needs.
  • Pedicle subtraction osteotomy and vertebral column resection are indicated for fused anterior columns and severe, focal, or multiplanar deformities.
  • More powerful osteotomies (PSO, VCR) carry higher complication rates than posterior-column osteotomies.

Conclusions:

  • The selection of posterior osteotomy technique is critical for successful adult spinal deformity correction.
  • Matching the osteotomy type to the specific spinal deformity and patient factors optimizes outcomes.
  • Balancing correction potential with complication risk is essential in surgical planning for adult spinal deformity.